| NPI | 1639923576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-24-333476) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCM.0106506-P) |
| Enumeration Date | 2024-04-16 |
| Last Update Date | 2024-05-09 |