| NPI | 1780156158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: CA 23537) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2018-12-26 |
| Last Update Date | 2023-04-13 |