| NPI | 1154879401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 020622) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 003740) |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2017-10-27 |