| NPI | 1548845548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: FL 17702) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL 34057) |
| Enumeration Date | 2021-03-11 |
| Last Update Date | 2021-03-11 |