| NPI | 1366817124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 120849) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT 15233) |
| Enumeration Date | 2015-12-04 |
| Last Update Date | 2021-07-19 |