| NPI | 1770104820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AZ OTH-008295) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WA OT60848942) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2020-11-10 |