| NPI | 1679101604 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 225800000X Recreation Therapist | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2021-01-26 |