| NPI | 1659750248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NE 2112) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: NV 15-0574) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2021-01-14 |