| NPI | 1669597159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WV 1105) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MD 05553) |
| 225X00000X Occupational Therapist (Licence: PA OC010354) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-07-08 |