| NPI | 1750790242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MA 11123) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: RI OT01435) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2023-07-11 |