| NPI | 1801398318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: CA 22654) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2021-09-28 |