| NPI | 1700514668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NJ 46TA09224100) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: NY 011065) |
| Enumeration Date | 2022-08-09 |
| Last Update Date | 2022-08-09 |