| NPI | 1750110045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MO 2023026684) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2024026684) |
| Enumeration Date | 2024-07-26 |
| Last Update Date | 2024-07-29 |