| NPI | 1669072849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NJ 46TR00925500) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC017304) |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2020-12-16 |