| NPI | 1174852719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MD 04997) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: DC ot00000149) |
| Enumeration Date | 2009-12-10 |
| Last Update Date | 2009-12-10 |