| NPI | 1659854651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 303119) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA 18-64872) |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2022-11-18 |