| NPI | 1942661285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 298510) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NV 15-02320) |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2022-05-10 |