| NPI | 1629367305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: SC 3637) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 000274-1) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2012-09-25 |