| NPI | 1285168294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 021385) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: NY 021385) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2019-12-11 |