| NPI | 1679517361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: DE U1-0000828) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: DE U1-0000828) |
| 225X00000X Occupational Therapist (Licence: PA OC004744L) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2020-09-09 |