| NPI | 1053831495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC014936) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: IA 119112) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2023-03-08 |