| NPI | 1306108873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 8304) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CT 003443) |
| 376G00000X Nursing Home Administrator (Licence: CT 001929) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2012-06-11 |