Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT11297 | CA |
NPI | 1043522386 |
---|---|
Provider Name | Mohammed Radwan Abu Sammoor |
First Address | Arcadia, CA 91006-2314 |
Second Address | Arcadia, CA 91006-2314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 01/07/2010 |