| NPI | 1649041765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WA 61485467) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 123921) |
| Enumeration Date | 2024-01-09 |
| Last Update Date | 2024-01-09 |