| NPI | 1326203423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 109355) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MS OT2231) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2008-07-28 |