| NPI | 1518487396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-5337) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-17-35597) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-01-14 |