| NPI | 1184295495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NC 13940) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: NC 13940) |
| Enumeration Date | 2021-07-07 |
| Last Update Date | 2025-10-10 |