| NPI | 1770977357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 0188201) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 115784) |
| 225X00000X Occupational Therapist (Licence: MA 11111) | |
| 225X00000X Occupational Therapist (Licence: CT 003745) | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2015-03-23 |