| NPI | 1649741810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: MI 5202010028) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA16951) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2023-05-25 |