| NPI | 1255817706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 125472) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 215212) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2025-03-30 |