| NPI | 1952035081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10085790) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2023-06-09 |