| NPI | 1144365586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC004531L) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ 46TR00164100) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-11-20 |