| NPI | 1104542257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist |
| Additional Taxonomies | 225XE0001X Occupational Therapist, Environmental Modification |
| 225XM0800X Occupational Therapist, Mental Health | |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2022-10-19 |