| NPI | 1083961593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT20777) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA OT13692) |
| 225X00000X Occupational Therapist (Licence: NJ 46TR00477400) | |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2021-03-10 |