| NPI | 1487170361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NM 3156) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 117379) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2022-07-21 |