| NPI | 1528307014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MD 06939) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 012885-1) |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2013-02-04 |