| NPI | 1609456268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: KY 266003) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TN 0000006627) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2021-04-08 |