| NPI | 1720447204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: NY 007442) |
| Additional Taxonomies | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: NJ 46TR00309900) |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2016-02-12 |