| NPI | 1891331419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WA CB61025168) |
| Enumeration Date | 2019-11-19 |
| Last Update Date | 2020-01-16 |