| NPI | 1093148751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: GA OT004135) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO009155) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2025-05-14 |