| NPI | 1003553025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT22203163) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL BACB749557) |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2022-05-24 |