| NPI | 1508217845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: CO OTA.0000768) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: GA OTA001907) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2016-06-28 |