| NPI | 1780299487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9626177) |
| Additional Taxonomies | 104100000X Social Worker |
| 106S00000X Behavior Technician (Licence: FL RBT-20-128048) | |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2023-03-28 |