| NPI | 1932643616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: NY 025803) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: NY 009167) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2021-08-12 |