| NPI | 1689257941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NJ 46TR00966500) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC017409) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2023-03-23 |