| NPI | 1235952300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 119575) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 411642) |
| Enumeration Date | 2024-11-06 |
| Last Update Date | 2025-09-16 |