| NPI | 1649672338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: TX 208434) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2021648) |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2014-09-24 |