| NPI | 1659965838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: GA OTA001697) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: CA OTA3164) |
| Enumeration Date | 2021-02-27 |
| Last Update Date | 2021-02-27 |