| NPI | 1770973273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MA 11540) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: MA 3129) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2023-09-20 |