| NPI | 1699396697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 024540-01) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 008957-1) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2020-04-30 |