| NPI | 1093811135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: GA OT003941) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MD 05542) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-08 |