| NPI | 1356101414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Q00000X Developmental Therapist |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-24-332334) |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2025-06-14 |