| NPI | 1568085934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: FL ota18536) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT20117954) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2024-10-07 |