| NPI | 1922758051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: MS RBT-19-89653) |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: MS 64000) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2022-03-23 |