| NPI | 1649832254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 120045) |
| Additional Taxonomies | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: TX 120045) |
| 225XP0200X Occupational Therapist, Pediatrics (Licence: TX 120045) | |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2020-11-24 |