| NPI | 1639567357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: PA OP007879) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: PA OP007879) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2015-01-05 |