| NPI | 1144871112 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-25-461991) | 
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA26880) | 
| Enumeration Date | 2019-09-21 | 
| Last Update Date | 2025-09-02 |