| NPI | 1942662440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2016005668) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 225200000X Physical Therapy Assistant (Licence: KS 14-03000) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2022-07-28 |