| NPI | 1629898143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TN 8158) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TN 5513) |
| Enumeration Date | 2024-10-10 |
| Last Update Date | 2024-10-10 |