| NPI | 1629012018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 2161) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NC 2161NC) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-08-13 |