| NPI | 1982277109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT44071) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: FL 0-23-14698) |
| Enumeration Date | 2021-07-24 |
| Last Update Date | 2025-12-05 |