| NPI | 1548044274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 030023-01) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: NY 009786) |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2025-05-07 |