| NPI | 1154467298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 120146) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TN OT4021) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2019-08-22 |