| NPI | 1528433299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XG0600X Occupational Therapist, Gerontology (Licence: WI 572426) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WI 5724-26) |
| 225X00000X Occupational Therapist (Licence: NM 2026-0123) | |
| Enumeration Date | 2015-12-07 |
| Last Update Date | 2026-08-18 |