| NPI | 1003325838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11006681) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2021-05-04 |