| NPI | 1821636739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL 23253) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA 14287) |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2026-04-13 |