| NPI | 1386973600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MO 2009028272) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NM 2615) |
| 225X00000X Occupational Therapist (Licence: IL 056.008623) | |
| 225X00000X Occupational Therapist (Licence: TX 113299) | |
| Enumeration Date | 2009-12-15 |
| Last Update Date | 2009-12-15 |