| NPI | 1144862335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: ME OT3580) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA OTL36037) |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2025-04-28 |