| NPI | 1538707153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL 23679) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-12-13 |
| Last Update Date | 2022-11-21 |