| NPI | 1093524571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX 6843) |
| Additional Taxonomies | 224ZR0403X Occupational Therapy Assistant, Driving and Community Mobility |
| 225400000X Rehabilitation Practitioner | |
| 251C00000X Day Training, Developmentally Disabled Services | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2024-12-30 |
| Last Update Date | 2025-01-09 |