| NPI | 1669863411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: ID OT-1629) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: IA 077135) |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2018-04-17 |