| NPI | 1063961704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: DE U2-0001591) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: MD A02239) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2016-09-22 |