| NPI | 1295926996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 116676) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT2557) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2018-10-25 |