| NPI | 1447624820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: VT 072.0000117) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT 14589) |
| Enumeration Date | 2015-11-22 |
| Last Update Date | 2015-11-22 |