| NPI | 1003966433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CO 1033890) |
| 225XP0200X Occupational Therapist, Pediatrics (Licence: CO 1033890) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2024-04-04 |