| NPI | 1265723043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: GA OT003857) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: SC 3445) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-04-27 |