| NPI | 1003424185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-20-122-174) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2020-07-15 |