| NPI | 1366819518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 108197) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: VA 0119005955) |
| 225X00000X Occupational Therapist (Licence: NM 3076) | |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2015-08-24 |