| NPI | 1578663464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: PA OC006308L) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: FL OT 10752) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2007-07-08 |