| NPI | 1720863467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC018204) |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2023-08-30 |