| NPI | 1205339256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: KY 175128) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: KY 175128) |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2018-12-01 |