| NPI | 1265519797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: KY KY R3535) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OH OT 006576) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |