| NPI | 1780397901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: LA 333138) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 123285) |
| Enumeration Date | 2023-01-03 |
| Last Update Date | 2024-10-23 |