| NPI | 1558879478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 022223) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CO OT0006218) |
| Enumeration Date | 2018-01-12 |
| Last Update Date | 2019-11-18 |