| NPI | 1801200605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 3552) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P12219) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2024-12-17 |