| NPI | 1649744103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WY OT-1394) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: AZ OTH-007666) |
| 225X00000X Occupational Therapist (Licence: PA oc015085) | |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2019-02-27 |