| NPI | 1790323673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: GA OT007308) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL 20473) |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2021-04-30 |