| NPI | 1710701065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: LA 345502) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: LA OTA.200414) |
| Enumeration Date | 2024-11-13 |
| Last Update Date | 2025-03-17 |