| NPI | 1417381146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 8003) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC011109) |
| 225X00000X Occupational Therapist (Licence: FL OT15938) | |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2013-08-29 |