| NPI | 1609377860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator (Licence: FL CCM100265-AC) | |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2020-10-12 |