| NPI | 1871953331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: AR OT-A1008) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: AR OT-A1008) |
| Enumeration Date | 2016-02-26 |
| Last Update Date | 2016-02-26 |