| NPI | 1861785198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NC 0999) |
| Additional Taxonomies | 251E00000X Home Health (Licence: NC 0999) |
| 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: NC 0999) | |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2011-05-19 |