| NPI | 1508638412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MD 10113) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OH OT009737) |
| Enumeration Date | 2023-10-24 |
| Last Update Date | 2024-11-27 |