| NPI | 1508246174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: GA OT006190) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT16972) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2015-06-08 |