| NPI | 1376883777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: VT 072.0000436) |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2023-05-02 |