| NPI | 1134694995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC014920) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ pending) |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2021-05-25 |