| NPI | 1780411280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9667124) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-22-224424) |
| 163WC1500X Registered Nurse, Community Health (Licence: FL RN9667124) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL RN9667124) | |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2024-09-18 |