| NPI | 1124507033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: VT 073.0900339PROV) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: NY 009819) |
| 224Z00000X Occupational Therapy Assistant (Licence: MT OTP-OTA-LIC-6122) | |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2026-04-21 |