| NPI | 1619675113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 15577) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: SC 7827) |
| Enumeration Date | 2023-02-23 |
| Last Update Date | 2025-11-26 |