| NPI | 1972298933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: DC OTA200001248) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: MD A03116) |
| 225700000X Massage Therapist (Licence: DC MT1354) | |
| Enumeration Date | 2023-04-06 |
| Last Update Date | 2023-04-06 |