| NPI | 1023607769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: OR 385768) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: AZ OTH-007071) |
| Enumeration Date | 2021-01-17 |
| Last Update Date | 2021-08-19 |