| NPI | 1962648394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 115501) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 25 002833) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2016-07-26 |