| NPI | 1124713821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: UT 13431730-4201) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NV OT-3209) |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2024-06-20 |