| NPI | 1750092482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: WA 317468) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: ID OTA2285) |
| Enumeration Date | 2022-12-13 |
| Last Update Date | 2022-12-13 |