| NPI | 1396810479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225800000X Recreation Therapist (Licence: CO 0011) |
| Additional Taxonomies | 225500000X Specialist/Technologist (Licence: CO 0049) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2007-07-08 |