| NPI | 1265791669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT19067) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: FL OT19067) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2022-03-29 |