| NPI | 1891039921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NJ 46TR00574000) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC-011208) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2013-06-25 |