| NPI | 1568738771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: VA 0119005676) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MD 06919) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2012-07-11 |