| NPI | 1336964469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant |
| 225XP0200X Occupational Therapist, Pediatrics | |
| Enumeration Date | 2024-11-22 |
| Last Update Date | 2024-11-22 |