| NPI | 1609078757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 6568) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: SC 3274) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2013-07-22 |