| NPI | 1821561119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: PR 1199) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PR 3299) |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2019-01-09 |