| NPI | 1669172003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT22511) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NC 15795) |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2023-03-06 |