| NPI | 1104469337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225800000X Recreation Therapist (Licence: CA 81242) |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: CA 5663-T) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2019-10-21 |