| NPI | 1124374988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 017182) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NY CO003271) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2012-07-31 |