| NPI | 1679080410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT20926) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: 15-04279) |
| Enumeration Date | 2018-01-02 |
| Last Update Date | 2020-10-09 |