| NPI | 1013406453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 022407) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043697) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2018-11-15 |