| NPI | 1508573445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 027219) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ 46TR072300) |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2022-10-31 |