| NPI | 1235771635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: NY 024073) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CT 5277) |
| 225X00000X Occupational Therapist (Licence: NY 024073) | |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2019-10-17 |