| NPI | 1053927129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: HI OTA-161) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: MO 2018003111) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2020-09-23 |