| NPI | 1962892786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XG0600X Occupational Therapist, Gerontology (Licence: SC OT.5241) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NC 5448) |
| Enumeration Date | 2015-02-01 |
| Last Update Date | 2018-05-01 |