| NPI | 1780404517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CA 54581) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2024-10-16 |
| Last Update Date | 2026-02-03 |