| NPI | 1174214605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist Pediatrics (Licence: OH OT.010404) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC015264) |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2024-08-22 |