| NPI | 1215425806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: KY 260371) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL 19178) |
| Enumeration Date | 2018-04-29 |
| Last Update Date | 2024-08-08 |