| NPI | 1508134263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: AZ 4975) |
| Additional Taxonomies | 225XN1300X Occupational Therapist, Neurorehabilitation (Licence: CA 12640) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2014-08-14 |