| NPI | 1891252623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant |
| 251E00000X Home Health | |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2020-12-08 |