| NPI | 1104036938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CA 9522) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ 46TR00407800) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2013-01-15 |