| NPI | 1497818140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AZ 3402) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA 9576) |
| 225X00000X Occupational Therapist (Licence: GA 2607) | |
| Enumeration Date | 2006-12-17 |
| Last Update Date | 2008-12-09 |