| NPI | 1811492606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 120371) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: KY 241065) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2022-06-03 |