| NPI | 1154792422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: TN 2587) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: VA 0131001482) |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2015-10-13 |