| NPI | 1750160941 |
|---|---|
| Former Name | MAXWELL JAMES LUSTICK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: TX 118563) |
| Enumeration Date | 2023-09-26 |
| Last Update Date | 2023-09-26 |