| NPI | 1154684637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NC 3159) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NC 2189) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2012-06-20 |