| NPI | 1376018622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 28539) |
| Enumeration Date | 2018-10-12 |
| Last Update Date | 2024-10-09 |