| NPI | 1356890685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WV 1995) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MD 07830) |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2022-07-12 |