| NPI | 1912064395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AR OTR1762) |
| Additional Taxonomies | 171W00000X Contractor (Licence: AR OTR1762) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2022-03-10 |