| NPI | 1770720237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 4542) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT11964) |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2011-09-15 |