| NPI | 1942768858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC015577) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ 46TR00820500) |
| Enumeration Date | 2019-03-10 |
| Last Update Date | 2020-04-27 |