| NPI | 1174092928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC015387) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ 46TR00601300) |
| Enumeration Date | 2018-11-21 |
| Last Update Date | 2018-11-21 |