| NPI | 1407321912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MA 12774) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: HI OT-1805) |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2018-10-11 |