| NPI | 1154784353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC019710) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ 46TR01065300) |
| 224Z00000X Occupational Therapy Assistant (Licence: NJ 46TA09120100) | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2024-04-01 |