| NPI | 1194101626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: RI OT01436) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA 11622) |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2015-08-06 |