| NPI | 1497499065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NJ 46TA09101500) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 216102) |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2022-04-20 |