| NPI | 1639663529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CA 15852) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ 46TR00686900) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2018-06-14 |