| NPI | 1760060859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: VA 0119-009412) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WY OT-1556) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2023-07-11 |