| NPI | 1699068072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-19-97850) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA60427) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2022-10-06 |