| NPI | 1326553843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-20-45171) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL 19102206) |
| 225700000X Massage Therapist (Licence: FL MA48822) | |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2020-10-29 |