| NPI | 1639310956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: FL 1467) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT10567) |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2021-09-17 |