| NPI | 1477167559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2020-09-04 |