| NPI | 1679689566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: LA OTT.Z12349) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 05284) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2016-07-25 |