| NPI | 1477015162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AR OTR2824) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA OT17581) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2020-01-28 |