NPI | 1629569801 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CA 23944) |
Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA 18-56053) |
Enumeration Date | 2018-05-23 |
Last Update Date | 2022-07-26 |