| NPI | 1932627254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NJ 46TR00784800) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 021455) |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2017-09-07 |