| NPI | 1790148286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT17628) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: AL 4179) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2016-04-01 |