| NPI | 1396390415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: WA 60984452) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant |
| 224ZE0001X Occupational Therapy Assistant Environmental Modification (Licence: WA 60984452) | |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2020-10-14 |