| NPI | 1548540560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT 13861) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NC 6656) |
| 225X00000X Occupational Therapist (Licence: NY 016196) | |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2011-08-22 |