| NPI | 1760872170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CA OT6746) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CA CO1498) |
| Enumeration Date | 2015-01-24 |
| Last Update Date | 2015-01-24 |