| NPI | 1013552264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: VA 0119008390) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: VA 0119008390) |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2019-11-12 |