| NPI | 1134835671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: SC 4028) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NC 4028) |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2023-03-03 |