| NPI | 1508995002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 013754) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: NY 013754) |
| 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: NY 013754) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2014-06-19 |