| NPI | 1255704136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 117267) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 020123) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2015-11-02 |