| NPI | 1548430994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AR OTR2114) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MO 2007009350) |
| Enumeration Date | 2008-03-01 |
| Last Update Date | 2008-03-01 |