| NPI | 1104884055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: OR 1016749) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NH 1093) |
| 225X00000X Occupational Therapist (Licence: VT 0720000310) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2007-07-08 |