| NPI | 1083647127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: LA OTTZ12348) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 06302) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2013-08-06 |