| NPI | 1508370461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC015376) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA OC015376) |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2022-07-20 |