| NPI | 1558464768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT13217) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA38170) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2011-07-18 |