| NPI | 1457697765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: PA OP007266) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: NY 008095-1) |
| Enumeration Date | 2012-12-14 |
| Last Update Date | 2012-12-14 |