| 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 |