| NPI | 1336866060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-034807) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2026-06-09 |