| NPI | 1053757963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WV 1579) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC012835) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2013-05-17 |