| NPI | 1679210678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-24-352829) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 2022009455) |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2024-08-06 |