| NPI | 1780043091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA18819) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: MO 2008034752) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2022-09-27 |