| NPI | 1427393818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: OK 5282) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: AR OTA737) |
| 224Z00000X Occupational Therapy Assistant (Licence: OK 1293) | |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2022-02-28 |