| NPI | 1518198613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: OH OTR/L 009094) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 07343) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2020-01-23 |