| NPI | 1316467327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: GA OT007045) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT18584) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2019-03-19 |