| NPI | 1366911257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WY OT-1425) |
| Additional Taxonomies | 225XG0600X Occupational Therapist Gerontology |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2019-07-18 |