| NPI | 1770616146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CT 000714) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA 1938) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2007-07-08 |