| NPI | 1164813846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: SC 4890) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: NC 9482) |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2017-06-09 |