| NPI | 1811717572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-24-385573) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL F8T4Z7Y8) |
| Enumeration Date | 2024-10-16 |
| Last Update Date | 2026-04-07 |