| NPI | 1801433297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA OT024665) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2025-05-27 |