| NPI | 1659922359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-25-79583) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA14575) |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2025-02-27 |