| NPI | 1164972709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NJ 46TR00588400) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 63017424) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2016-10-06 |