| NPI | 1619357076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: SC 3024) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: GA OTA000117) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2018-03-08 |