| NPI | 1952058455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: TX 217350) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA15482) |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2022-04-20 |