| NPI | 1467797118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: TX 211930) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: OH OTA.04763) |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2012-12-06 |