| NPI | 1831770882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MD 09257) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A4265) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-04-20 |