| NPI | 1750123253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WA OT61675911) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics |
| Enumeration Date | 2024-06-07 |
| Last Update Date | 2025-11-24 |