| NPI | 1366025983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL 20-143902) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-05-02 |
| Last Update Date | 2021-05-17 |