| NPI | 1346499092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 107760) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OK 779) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2015-10-13 |