| NPI | 1831665264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NM OT-2023-0251) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 215409) |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2024-03-21 |