| NPI | 1679230304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AK 185083) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC004861L) |
| Enumeration Date | 2021-11-17 |
| Last Update Date | 2021-11-17 |