| NPI | 1639889645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CO OT.0007710) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: CO NA.00799646) |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2022-11-30 |