| NPI | 1407380199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT1853140) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: FL CNA341021) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2018-05-27 |