| NPI | 1437482957 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: LA OTT.Z11853)  | 
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 019746-1)  | 
| Enumeration Date | 2009-09-15 | 
| Last Update Date | 2015-06-25 |