| NPI | 1356621163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 12625) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WV 1738) |
| 225X00000X Occupational Therapist (Licence: AR OTR2444) | |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2019-08-13 |