| NPI | 1992210801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: KY 135427) |
| Additional Taxonomies | 224ZE0001X Occupational Therapy Assistant, Environmental Modification (Licence: KY 135427) |
| Enumeration Date | 2017-12-14 |
| Last Update Date | 2017-12-14 |