| NPI | 1720625262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: MA 3468) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MA 7603) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2019-12-03 |