| NPI | 1154797660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 116230) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NM 3411) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2015-08-19 |