| NPI | 1851663082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT020180) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2020-08-19 |