| NPI | 1649887852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WY OT-1558) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC017134) |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2021-04-02 |