| NPI | 1952444952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: GA OT000783) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: NC 6316) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2007-07-09 |