| NPI | 1174343545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-24-384038) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCM.0107167-P) |
| Enumeration Date | 2024-10-11 |
| Last Update Date | 2024-11-14 |