| NPI | 1306524541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC019239) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ 46TR01129000) |
| Enumeration Date | 2023-07-07 |
| Last Update Date | 2023-07-25 |