| NPI | 1861540973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: ND 662) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: MN 102480) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2019-01-17 |