| NPI | 1396512489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-23-316913) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2023-12-07 |
| Last Update Date | 2026-03-12 |