| NPI | 1104489541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT20484) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 023544) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2023-07-17 |