| NPI | 1174750384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: NY 009133-1) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: DC OT010000440) |
| 225X00000X Occupational Therapist (Licence: GA OT002773) | |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2015-05-28 |