| NPI | 1043662794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: GA OT0009733) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CO 0004684) |
| 225XP0200X Occupational Therapist, Pediatrics (Licence: MI 5201013385) | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2026-05-12 |