| NPI | 1801846530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WV 1028) |
| Additional Taxonomies | 171W00000X Contractor (Licence: WV 1028) |
| 171W00000X Contractor (Licence: MD 4890) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2024-12-26 |