| NPI | 1255759296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 018681) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA 11162) |
| Enumeration Date | 2014-04-06 |
| Last Update Date | 2014-04-06 |