| NPI | 1255444923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 112946) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: FL 0006886) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2010-09-09 |