| NPI | 1740843150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: IA 108506) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NV OT-2190) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2021-12-22 |