| NPI | 1770935785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MA 11271) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: GA 5977) |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2016-07-01 |