| NPI | 1275991622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: CA 398) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 4109) |
| Enumeration Date | 2016-01-31 |
| Last Update Date | 2016-01-31 |