| NPI | 1568201317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CA 8966) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2024-05-22 |