| NPI | 1780291203 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: SC 6238) | 
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CO 442854) | 
| Enumeration Date | 2020-09-29 | 
| Last Update Date | 2025-06-30 |