| NPI | 1124141411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: TN 2314) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TN 2314) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2008-06-23 |