| NPI | 1518172790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC002845L) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MD 02602) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2019-10-23 |