| NPI | 1790083772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NY 002896-01) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: NY 002896-1) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2021-05-27 |