| NPI | 1760806780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA17480) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 213057) |
| 224Z00000X Occupational Therapy Assistant (Licence: FL OTA12927) | |
| Enumeration Date | 2014-02-11 |
| Last Update Date | 2020-08-10 |