| NPI | 1821654658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WA OT60865394) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA 17900) |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2021-10-15 |