| NPI | 1578117909 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NJ 46TR00336200) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00017000) |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2019-07-24 |