| NPI | 1649483595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: KY R1507) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: IN 31003703A) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-08 |