| NPI | 1992003198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: TX 2023182) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ 0210A) |
| 225200000X Physical Therapy Assistant (Licence: OR 7654) | |
| Enumeration Date | 2011-03-11 |
| Last Update Date | 2011-03-11 |