| NPI | 1528958873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 17986) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: NC 17770) |
| Enumeration Date | 2025-07-08 |
| Last Update Date | 2025-09-15 |