| NPI | 1043635691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 5093) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: SC 2683) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2026-04-22 |