| NPI | 1265234454 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225XM0800X Occupational Therapist, Mental Health |
| Enumeration Date | 2025-03-26 |
| Last Update Date | 2025-03-26 |