| NPI | 1699912303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: NY 010103-1) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: CT 003153) |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2009-01-16 |