| NPI | 1326504390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: DC 010001530) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: VA 0119007851) |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2021-12-10 |