| NPI | 1912266560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: FL OT21908) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT21908) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2024-05-24 |