| NPI | 1215496468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2022-11-10 |