| NPI | 1992688436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-25-456513) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 2791) |
| Enumeration Date | 2025-07-30 |
| Last Update Date | 2025-10-04 |