| NPI | 1346713831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC011935) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WV 1849) |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2019-01-07 |