| NPI | 1487207023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NE 901261) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MN RBT-22-214746) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2026-06-02 |