| NPI | 1174890834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 121154) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 211315) |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2021-08-30 |