| NPI | 1457710709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NV OT-2564) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2021-06-14 |