| NPI | 1104533322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 026952) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 030783) |
| Enumeration Date | 2022-10-28 |
| Last Update Date | 2022-10-28 |