| NPI | 1790566925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: IL RBT-21-191172) |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2025-01-06 |