| NPI | 1770651390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: ID OT-2073) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA OT00003293) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2021-10-14 |