| NPI | 1356913495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: VA 0119-009083) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA OT22058) |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2021-09-01 |