| NPI | 1891750964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: VA 0119004720) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MD 05675) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2008-06-18 |