| NPI | 1982172409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A199100) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 106S00000X Behavior Technician (Licence: CA RBT-18-68672) | |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2026-04-01 |