| NPI | 1851635130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: PA OP003392L) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: OH OTA.04619) |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2012-11-26 |