| NPI | 1659918613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: VT 073.0900257) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: NY 010270) |
| Enumeration Date | 2019-12-09 |
| Last Update Date | 2019-12-09 |