| NPI | 1780235754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT21109) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA15002) |
| Enumeration Date | 2019-09-21 |
| Last Update Date | 2020-10-14 |