| NPI | 1306358700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC013291) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MD 08303) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2018-06-16 |