| NPI | 1629638309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: OR 415849) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CO 0005952) |
| Enumeration Date | 2019-06-16 |
| Last Update Date | 2019-06-16 |