| NPI | 1669111811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 029240-01) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CT 5597) |
| Enumeration Date | 2022-06-03 |
| Last Update Date | 2024-11-19 |