| NPI | 1639668593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: GA OT007020) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NC 12251) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2019-01-14 |