| NPI | 1851703979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60443138) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2023-08-28 |