| NPI | 1740892959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC017714) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OH OT011031) |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2021-09-27 |