| NPI | 1619627403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-22-206943) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2025-03-13 |