| NPI | 1104299932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CA 14505) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NV 16-0721) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2019-11-04 |