| NPI | 1669123063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NJ 46TR01105000) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC004911L) |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2023-08-01 |