| NPI | 1972733517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA9949) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2020-01-29 |