| NPI | 1821553579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT--19-88688) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: FL C663112903640) |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2021-11-12 |