| NPI | 1902323918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 019458) |
| Additional Taxonomies | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: NY 019458) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2022-07-21 |