| NPI | 1265793160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: VA 0119005308) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019008482) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2019-10-22 |