| NPI | 1063703577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WA OT002923) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: ID OT-975) |
| 225X00000X Occupational Therapist (Licence: CA OT 10244) | |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2011-05-02 |