| NPI | 1972912863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NM OTA4558) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: VA 0131001202) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2022-10-12 |