| NPI | 1992136717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NM OT4569) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NM 3102) |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2022-02-02 |