| NPI | 1467749028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MA 13542) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: MA 4028) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2020-05-15 |