| NPI | 1952871899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 16282) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-12-04 |
| Last Update Date | 2026-03-23 |