| NPI | 1174175020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: FL RN9498619) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2026-07-14 |