| NPI | 1881913804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OR 677013) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2012-08-20 |