| NPI | 1366726960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WI 4997-26) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: IA 002157) |
| 225X00000X Occupational Therapist (Licence: MN 104051) | |
| Enumeration Date | 2011-10-01 |
| Last Update Date | 2011-10-01 |