NPI | 1730830498 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: MD 09005) |
Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: NJ 46TR01081800) |
Enumeration Date | 2022-01-14 |
Last Update Date | 2023-11-28 |