| NPI | 1043061310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: MA 2964) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 7996) |
| Enumeration Date | 2024-03-27 |
| Last Update Date | 2024-03-27 |