| NPI | 1356381081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AL 1786) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH4270) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2007-07-08 |