| NPI | 1376976720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT20154) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA12139) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2019-06-21 |