| NPI | 1902289317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CT 003398) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA 11046) |
| 225X00000X Occupational Therapist (Licence: RI OT0038) | |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2015-07-02 |