| NPI | 1558739037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 019439) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CT 004373) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2017-03-02 |