| NPI | 1184199754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: AK 136624) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: AK 136624) |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2018-10-09 |