| NPI | 1366480477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: SC 6219) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: FL OT8940) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2025-08-23 |