| NPI | 1164773768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Q00000X Developmental Therapist (Licence: FL PT26976) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: PA PT020051) |
| 222Q00000X Developmental Therapist (Licence: IL 070.019226) | |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2012-09-24 |