| NPI | 1235509647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: WA OT 60490276) |
| Additional Taxonomies | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: OR 328753) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2015-09-28 |