| NPI | 1821618216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: KY 133794) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OH OT009146) |
| Enumeration Date | 2020-04-26 |
| Last Update Date | 2020-04-26 |