| NPI | 1760056717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT25503) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2024-12-27 |