| NPI | 1619902145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NJ 46TR00621200) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 014206) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2016-08-16 |