| NPI | 1255612743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: WA OT00000718) |
| Additional Taxonomies | 225XG0600X Occupational Therapist, Gerontology (Licence: WA OT00000718) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2011-08-29 |