| NPI | 1164197679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT21-179833) |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2023-02-14 |