| NPI | 1700136793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MA 10634) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA 12676) |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2012-09-17 |