| NPI | 1902365612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MD 08676) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: DC OT010001609) |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2021-10-26 |