| NPI | 1619404787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT21001) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WA OT60678041) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2020-10-08 |