| NPI | 1215915541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: PA OC011865) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 1075481) |
| 225X00000X Occupational Therapist (Licence: TX 113643) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2016-10-19 |