| NPI | 1104267459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 123391) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 212780) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2024-06-12 |