| NPI | 1740841691 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: OR 419597) | 
| Additional Taxonomies | 225XH1200X Occupational Therapist, Hand (Licence: OR 419597) | 
| Enumeration Date | 2019-06-21 | 
| Last Update Date | 2019-06-21 |