| NPI | 1548689078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AR OTR2859) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AR PTA2002) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2018-02-08 |