| NPI | 1962172577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 111929-01) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 026-126) |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2024-02-01 |