| NPI | 1942940796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NJ 46TR01048700) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 46TR01048700) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2022-11-03 |