| NPI | 1629512900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: KS 1702908) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MO 2010022884) |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2016-12-06 |