| NPI | 1124559877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: UT 12677476-4201) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2022-03-01 |