| NPI | 1841953411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT21593) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MI 1033388) |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2021-10-20 |