| NPI | 1568926996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 023244) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: VA 0119007899) |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2019-01-30 |