| NPI | 1871228858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NM OT-2023-0167) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: KY 242558) |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2023-10-17 |