| NPI | 1649573445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: MD a01808) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WV C 1756) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2022-12-02 |