| NPI | 1740905744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC018219) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NH 4220) |
| 225X00000X Occupational Therapist (Licence: CA 28122) | |
| Enumeration Date | 2022-10-11 |
| Last Update Date | 2026-06-23 |