| NPI | 1265968184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA7258) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: GA OTA001484) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |