| NPI | 1629584651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NV 13-0321) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 021668) |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2017-12-28 |