| NPI | 1154691376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WA OT 60133993) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT 14880) |
| 225X00000X Occupational Therapist (Licence: OR 1019660) | |
| 225X00000X Occupational Therapist (Licence: MI 5201004139) | |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2012-01-04 |