| NPI | 1437639820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: VA 0119007682) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TN OT0000005853) |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2018-08-15 |