| NPI | 1215559158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: IA 099585) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2020-05-14 |