| NPI | 1487869459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AZ 3740) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OH OT-006111) |
| 225X00000X Occupational Therapist (Licence: KY KY-R3005) | |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2007-07-08 |