| NPI | 1982810768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 118278) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NJ 46TR000311500) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2018-09-13 |