| NPI | 1639543101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: LA 325877) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 213065) |
| 225X00000X Occupational Therapist (Licence: TX 118818) | |
| Enumeration Date | 2015-11-21 |
| Last Update Date | 2024-08-15 |