| NPI | 1821388422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: NJ 46TR00524400) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 114927) |
| Enumeration Date | 2011-04-15 |
| Last Update Date | 2015-01-13 |