| NPI | 1306391040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306603629) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: VA RBT-16-17379) |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2016-09-02 |