| NPI | 1710538749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 51569) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-09-20 |
| Last Update Date | 2021-11-19 |