| NPI | 1265087738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AZ OTH-007887) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ MT-22762) |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2020-04-21 |