| NPI | 1255600110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: FL 12066) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: MN 200526) |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2011-12-22 |