| NPI | 1528652120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA91115554) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT15448) |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2022-02-09 |