| NPI | 1639161920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NV OT-2424) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: UT 352637-2401) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2019-12-11 |