| NPI | 1396257705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZA2600X Specialist/Technologist, Other, Art, Medical (Licence: NY 0014901) |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: NY 0014901) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2017-10-26 |