| NPI | 1457622243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XG0600X Occupational Therapist, Gerontology (Licence: FL OT8409) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT8409) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2014-11-25 |