| NPI | 1053879452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: VA 0119008143) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MD 07860) |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2025-04-23 |