| NPI | 1912209057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 011127-1) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: NY 011127-1) |
| Enumeration Date | 2010-11-22 |
| Last Update Date | 2019-07-14 |