| NPI | 1003221888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NM OTA22019) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: WI 5068-27) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2023-01-25 |