| NPI | 1316429152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 121021) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 213292) |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2021-07-28 |