| NPI | 1336408228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: KY r0056) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TN OT103) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2012-05-11 |