| NPI | 1992224646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XM0800X Occupational Therapist, Mental Health (Licence: CA 20728) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2023-07-07 |