| NPI | 1336662477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 119206) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OT15986) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2018-08-27 |