| NPI | 1902429558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CA 21726) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MN 106092) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2023-01-11 |