| NPI | 1639577570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WA OT60516108) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OR 334355) |
| 225X00000X Occupational Therapist (Licence: ID OT-1388) | |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2014-12-09 |