| NPI | 1578090122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Q00000X Developmental Therapist |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: NY 021340-1) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2022-07-21 |