| NPI | 1790818219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 010147-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 010147-1) |
| 225XP0200X Occupational Therapist, Pediatrics (Licence: NY 010147-1) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2008-11-10 |