| NPI | 1487229308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 025587) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT21742) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2021-05-24 |