| NPI | 1043962459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TN OTA0000003468) |
| Enumeration Date | 2022-01-26 |
| Last Update Date | 2024-11-04 |