| NPI | 1518367606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: HI RBT-22-248088) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AK 2352) |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2023-02-02 |