Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 012092-1 | NY |
NPI | 1275864043 |
---|---|
Provider Name | Mr. Troy Dale Gibson |
First Address | Buffalo, NY 14221-4653 |
Second Address | Buffalo, NY 14221-4653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2010 |
Last Update Date | 29/12/2021 |