| NPI | 1275925414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Q00000X Developmental Therapist |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: MA 117229367) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2018-03-23 |