| NPI | 1174036354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-18-62628) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-11-10 |
| Last Update Date | 2022-09-10 |