| NPI | 1508091877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AL 2996) |
| Additional Taxonomies | 227800000X Respiratory Therapist, Certified (Licence: AL 1034) |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2009-05-15 |