| NPI | 1043331580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: VT 072-0000494) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA 3845) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2007-07-08 |