| NPI | 1407286511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 018453) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ 46TR00640000) |
| 225700000X Massage Therapist (Licence: NY 023557) | |
| 225700000X Massage Therapist (Licence: NJ 18KT00075800) | |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2015-09-09 |