| NPI | 1821633611 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MI 5201012665) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-11-15 |
| Last Update Date | 2022-01-11 |