| NPI | 1861927014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X Technician, Other (Licence: 91056) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 112891) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2019-10-14 |