| NPI | 1629836002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: MI 5202010173) |
| Additional Taxonomies | 226000000X Recreational Therapist Assistant (Licence: MI 5202010173) |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2024-03-11 |