| NPI | 1346982964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL 20-136138) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2026-03-10 |