| NPI | 1154882223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL 21629) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: FL 13144) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2021-03-03 |