| NPI | 1609168186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: DC OT010000656) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: VA 0119005295) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2011-05-03 |