| NPI | 1376017327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: GA OT008447) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: ID OT-2018) |
| Enumeration Date | 2019-01-13 |
| Last Update Date | 2025-02-07 |