| NPI | 1588800254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: ME OT1027) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: ME MT1462) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2008-12-30 |