| NPI | 1639613698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-20-117956) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11032905) |
| Enumeration Date | 2016-12-10 |
| Last Update Date | 2024-06-13 |