| NPI | 1093113995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: ID OTA-1139) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: OR 295012) |
| 224Z00000X Occupational Therapy Assistant (Licence: NV 14-1230) | |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2014-12-09 |