| NPI | 1093265779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC014164) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WV 1862) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2016-10-06 |