| NPI | 1780036525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 117701) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CO OT4646) |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2016-07-05 |