| NPI | 1134349541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: KY 132643) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 225X00000X Occupational Therapist (Licence: KY R1929) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2016-06-06 |