| NPI | 1033830385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 2251P0200X Physical Therapist, Pediatrics | |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2022-09-06 |