| NPI | 1548722010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: WY OTA-1398) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2019-04-03 |