| NPI | 1962205575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NJ 46TR00905400) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: PA OC006402L) |
| Enumeration Date | 2025-03-29 |
| Last Update Date | 2025-03-29 |