| NPI | 1548883754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist |
| Additional Taxonomies | 225100000X Physical Therapist |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2020-05-21 |