| NPI | 1083772925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: KY 134498) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: KY 134498) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2021-01-13 |