| NPI | 1407416076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-19-95755) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: FL 26546599) |
| 225700000X Massage Therapist (Licence: FL MA65125) | |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2026-03-11 |