| NPI | 1164099966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2024-05-13 |