| NPI | 1932579349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: KS 17-03170) |
| Additional Taxonomies | 261QX0100X Clinic/Center Occupational Medicine (Licence: CO 0004416) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2016-12-19 |