NPI | 1972978542 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: MT 8563) |
Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WA 60468807) |
Enumeration Date | 2015-12-08 |
Last Update Date | 2021-10-12 |