| NPI | 1073981981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID OT-2257) |
| Additional Taxonomies | 225XM0800X Occupational Therapist, Mental Health |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2022-03-09 |