| NPI | 1003218462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 9390) |
| Additional Taxonomies | 225XM0800X Occupational Therapist, Mental Health (Licence: CO 8086) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2023-07-30 |