| NPI | 1114433661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-24-328358) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL CBHCMS0102799) |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2025-12-16 |