| NPI | 1477089944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NM OT4261) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 116277) |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2020-02-18 |