| NPI | 1093215337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA31560) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2022-08-03 |