| NPI | 1184163792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: OR 380280) |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2018-11-08 |