| NPI | 1689019762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 021396-1) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC012722) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2022-07-21 |