| NPI | 1164084620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: MI 5202008595) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 215683) |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2020-07-08 |