| NPI | 1578075578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: SC 7483) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: FL OT18640) |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2026-02-11 |