| NPI | 1164883872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: KS 18-01281) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: MO 2016002924) |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2016-03-09 |