| NPI | 1194840884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: OK 1924) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OK 1517) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2015-05-12 |