| NPI | 1578947099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MA 9996) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CT 4394) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2015-07-14 |