| NPI | 1043627755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 163W00000X Registered Nurse (Licence: FL RN9254356) | |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2025-10-14 |