| NPI | 1588000616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 225XM0800X Occupational Therapist Mental Health |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2017-08-01 |