| NPI | 1144928045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2023-02-20 |