| NPI | 1083349575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: IA 097034) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: KY 278766) |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2022-07-19 |