| NPI | 1073334553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-25-414974) |
| Additional Taxonomies | 172A00000X Driver (Licence: FL G640724021240) |
| Enumeration Date | 2024-10-17 |
| Last Update Date | 2025-02-28 |