| NPI | 1083230379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT23318) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: RI OT01752) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2023-02-10 |