| NPI | 1790062800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT19239) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA63588) |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2025-04-28 |