| NPI | 1336558923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: SC 5165) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NC 9454) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2018-12-20 |