| NPI | 1487161949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: CA 469965) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-01-05 |
| Last Update Date | 2022-05-03 |