| NPI | 1760720122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 014277) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ 46TR00602100) |
| Enumeration Date | 2013-01-19 |
| Last Update Date | 2019-03-18 |