| NPI | 1306205901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XG0600X Occupational Therapist, Gerontology (Licence: NM OT784) |
| Additional Taxonomies | 225XG0600X Occupational Therapist, Gerontology (Licence: NM 784) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2022-04-01 |