| NPI | 1649557547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: VA 0119006077) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MD 06222) |
| Enumeration Date | 2011-11-07 |
| Last Update Date | 2013-09-18 |