| NPI | 1629176391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: NY 029389) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: GA OT003641) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-12-13 |