| NPI | 1023754157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 122933) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: VA 0119-009477) |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2024-01-08 |