| NPI | 1225306244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NJ 46tr00339000) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX 117189) |
| Enumeration Date | 2011-12-05 |
| Last Update Date | 2024-01-18 |