| NPI | 1962704692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NM OT3783) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA 10676) |
| 225X00000X Occupational Therapist (Licence: AZ 5031) | |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2020-04-03 |