| NPI | 1306698188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225800000X Recreation Therapist |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: NY 85271) |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2024-05-07 |