| NPI | 1871871889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-20-118008) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA 60387) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2020-05-26 |