| NPI | 1609429562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-18-64281) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2022-05-15 |