| NPI | 1255955951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: MI 5201012815) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2022-04-22 |