| NPI | 1902573405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-6095) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: AZ RBT-21-181388) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2025-01-29 |