| NPI | 1023628765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: CO OTA.0001360) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: CO T-OTA.0000024) |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2022-07-21 |