| NPI | 1245796754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NC 9779) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: VA 0131000294) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2019-02-20 |