| NPI | 1619494291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 11479) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT18567) |
| 225X00000X Occupational Therapist (Licence: WY OT-1372) | |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2018-10-11 |