| NPI | 1194082065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 026689) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: NY 009209) |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2022-04-05 |