| NPI | 1700292497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NJ 46TR00624800) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NJ 18KT00966900) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2017-03-10 |