| NPI | 1528575396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 51008) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2022-12-30 |