| NPI | 1487947529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Q00000X Developmental Therapist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172A00000X Driver (Licence: AR 902998289) | |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2011-05-23 |