| NPI | 1427242478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: MN 102028) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: ND 285) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2018-03-21 |