| NPI | 1104941640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: DE U1-0000690) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC007485L) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2023-01-27 |