| NPI | 1043581853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC002574L) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 012673-1) |
| 225X00000X Occupational Therapist (Licence: CT 002927) | |
| 225X00000X Occupational Therapist (Licence: OH 004146) | |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2012-01-25 |