| NPI | 1821453051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 020242) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 020242-1) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2021-01-19 |