| NPI | 1164506531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: GA OT4558) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT5272) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2011-01-05 |