| NPI | 1043775992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 118821) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA 19232) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2019-06-03 |