| NPI | 1245005099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 102507) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 102507) |
| Enumeration Date | 2023-11-21 |
| Last Update Date | 2023-11-21 |