| NPI | 1710401146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CO OT.0008620) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: CO OTA.0000946) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2024-10-02 |