| NPI | 1578850160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102209193) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2025-06-18 |