| NPI | 1528256476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA 8790) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2019-04-15 |