| NPI | 1457046021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-23-308256) |
| Additional Taxonomies | 376K00000X Nurse's Aide |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2024-09-30 |