| NPI | 1346420254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CT 001627) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY 008822) |
| 225X00000X Occupational Therapist (Licence: NY 008822-1) | |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2020-12-31 |