| NPI | 1720139330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT12483) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: FL OT12483) |
| 225XH1200X Occupational Therapist Hand (Licence: FL OT12483) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-08-03 |