| NPI | 1962798314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: TX 211236) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA12262) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2019-02-07 |