| NPI | 1255708897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC011951) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 018237) |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2015-08-31 |