| NPI | 1023842002 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics | 
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: NE 2603) | 
| Enumeration Date | 2024-08-30 | 
| Last Update Date | 2024-08-30 |