| NPI | 1639109812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 119083) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: LA Z12105) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2025-06-17 |