| NPI | 1649050154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225800000X Recreation Therapist (Licence: TX 81644) |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: MS 81644) |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2023-10-02 |