| NPI | 1003315631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA OT024724) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-02-09 |
| Last Update Date | 2025-06-05 |