| NPI | 1104468198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 024390-01) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ 46TR00829100) |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2022-11-11 |