| NPI | 1669757407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT20147518) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA43722) |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2021-02-19 |