| NPI | 1609380377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NC 9623) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 021955-1) |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2017-11-16 |