| NPI | 1073165122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-19-91278) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 5732) |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2019-07-09 |