| NPI | 1205310125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XG0600X Occupational Therapist, Gerontology |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 225X00000X Occupational Therapist (Licence: FL OT15663) | |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2018-09-17 |