| NPI | 1528461126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2014-09-27 |
| Last Update Date | 2021-08-18 |