| NPI | 1265859391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: MO 2012013505) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: KS 18-00827) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2014-03-26 |