| NPI | 1790324101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XH1200X Occupational Therapist, Hand (Licence: GA OT008793) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 225XP0200X Occupational Therapist, Pediatrics (Licence: GA OT008793) | |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2025-06-30 |