| NPI | 1982867750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NC 6865) |
| Additional Taxonomies | 225700000X Massage Therapist |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2008-11-28 |