| NPI | 1437664034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG61006256) |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2019-11-21 |