| NPI | 1396851481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 010855-1) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA 4165) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2007-07-08 |