| NPI | 1225515661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA26087) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-23-254526) |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2023-02-08 |