| NPI | 1003681511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: AZ OTH-009382) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 123736) |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2023-11-15 |