| NPI | 1164578092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CT 1875) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 005411-1) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2025-05-21 |