| NPI | 1265733125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Q00000X Developmental Therapist (Licence: SC 24513) |
| Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: SC 24513) |
| 251E00000X Home Health (Licence: SC 24513) | |
| 385H00000X Respite Care (Licence: SC 24513) | |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2026-01-26 |