| NPI | 1871016295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT24282) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL4839) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2024-10-21 |