| NPI | 1013986504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NM 2516) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: AZ 2455) |
| 225X00000X Occupational Therapist (Licence: TX 106981) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2009-06-15 |