| NPI | 1003823360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WA OT60669325) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: KY KY-R2223) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2017-02-27 |