| NPI | 1811604085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2026-03-03 |