| NPI | 1689388944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: WA 60976943) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: ID 2070) |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2023-01-11 |