| NPI | 1245425180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 109967) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1181328) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2019-01-24 |