| NPI | 1700303930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 022871) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 174400000X Specialist | |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2018-09-05 |