| NPI | 1477715092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WA OT 60530123) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60083915) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2015-04-03 |