| NPI | 1083295349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MA 13726) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 022999) |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2021-04-19 |