| NPI | 1558748418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: SC 6031) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: GA OT006122) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2021-04-12 |