| NPI | 1497948921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 023024-1) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 023024) |
| 251C00000X Day Training, Developmentally Disabled Services (Licence: NY 006119-1) | |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2019-02-06 |