| NPI | 1134591712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: ME OT3637) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 117258) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2019-11-25 |