| NPI | 1700216645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL 21845) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: ID OT-1190) |
| Enumeration Date | 2013-11-13 |
| Last Update Date | 2021-08-19 |