| NPI | 1932353745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 225XH1200X Occupational Therapist, Hand | |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2019-10-11 |