| NPI | 1164197968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL BACB942424) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA91983) |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2024-02-08 |