| NPI | 1649833476 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CT 5493) |
| Additional Taxonomies | 225XM0800X Occupational Therapist, Mental Health (Licence: CT 5493) |
| 225XP0200X Occupational Therapist, Pediatrics (Licence: CT 5493) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2021-05-05 |