| NPI | 1639161540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: OK 1541) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WY OTR-550) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2024-04-21 |