| NPI | 1629192596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: RI OT00533) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA 3220) |
| Enumeration Date | 2007-03-18 |
| Last Update Date | 2007-07-08 |