| NPI | 1255777173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AZ 6034) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: AZ 4877) |
| Enumeration Date | 2013-05-18 |
| Last Update Date | 2018-05-30 |