| NPI | 1730831785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NM 4124) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-01-21 |
| Last Update Date | 2023-11-16 |