| NPI | 1609302009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: WY 1142) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: WY 1142) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2017-05-04 |