| NPI | 1386023430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 114465) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: AZ 3268) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2015-05-22 |