| NPI | 1225615230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CO OT.0008537) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2024-09-05 |