| NPI | 1831807361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NM OTA4672) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 217198) |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2022-11-14 |