| NPI | 1558434928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: ID OT-886) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: IA 00800) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2008-08-18 |