| NPI | 1639661515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: OH OT010082) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WV 1940) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2018-06-05 |