| NPI | 1679082879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: MA 4175) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: RI OTA00958) |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2017-09-20 |