| NPI | 1770973653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: MO 2005010151) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: KS 18-00633) |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2015-01-29 |