| NPI | 1174350532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 028774) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 028774) |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2024-09-18 |