| NPI | 1649093683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CO OT.0009175) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CO PTA.0014131) |
| Enumeration Date | 2024-11-07 |
| Last Update Date | 2025-12-18 |