| NPI | 1942631577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: FL 10740) |
| Additional Taxonomies | 225XG0600X Occupational Therapist, Gerontology (Licence: FL 10740) |
| Enumeration Date | 2013-12-08 |
| Last Update Date | 2017-04-05 |