| NPI | 1053282236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-25-443625) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCM.0107019) |
| Enumeration Date | 2025-09-12 |
| Last Update Date | 2025-10-22 |