| NPI | 1962032425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME167425) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 106S00000X Behavior Technician (Licence: FL RBT-20-110653) | |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2024-06-20 |