| NPI | 1437703667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA Y8384935) |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2022-03-17 |