| NPI | 1205055852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225XH1200X Occupational Therapist, Hand (Licence: NY 013910-1) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2019-06-24 |