| NPI | 1366142994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: VA 0119009848) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: VT 072.0134307FCTY) |
| 225X00000X Occupational Therapist (Licence: PA OC017909) | |
| 225X00000X Occupational Therapist (Licence: MA 14562) | |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2023-03-02 |