| NPI | 1114668167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NH 457925) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NM OT-2024-0038) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2024-03-08 |