| NPI | 1679555767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC007052L) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ 46TR00059100) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2024-01-22 |