| NPI | 1134405673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: VA 0131000941) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: NM 2624) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2011-10-28 |