| NPI | 1245632421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: TX 208943) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 208943) |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2021-09-17 |