| NPI | 1205604337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: WY COTA-1130) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: WY 337173) |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2023-12-18 |