| NPI | 1588173256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: ME OT4131) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2022-01-20 |