| NPI | 1790847457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT 4720) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NC 5989) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2007-07-09 |