| NPI | 1821707365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT24622) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA17274) |
| Enumeration Date | 2022-11-22 |
| Last Update Date | 2023-10-12 |