| NPI | 1770144560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT26105) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA26276) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2025-05-23 |