| NPI | 1942972237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-20-149089) |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2026-04-25 |