| NPI | 1205246162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WV 1675) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: VA 0119006099) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2014-04-30 |