| NPI | 1386038966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERRILL MARTIN Owner 904-465-0090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1063045) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2015-03-23 |