| NPI | 1164985925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AZ OTH-007784) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WA OT61033593) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2020-03-17 |