| NPI | 1679712608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 110317) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL OT11886) |
| Enumeration Date | 2009-02-15 |
| Last Update Date | 2021-01-26 |