| NPI | 1679697502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: RI OTA00383) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: MA 03018) |
| 224Z00000X Occupational Therapy Assistant (Licence: CT 001008) | |
| Enumeration Date | 2007-03-17 |
| Last Update Date | 2007-07-08 |