| NPI | 1962288779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10097097) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-23-296349) |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2026-06-28 |