| 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 |