| NPI | 1205205945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA24457) |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2020-05-28 |