| NPI | 1811640493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 109604) |
| Additional Taxonomies | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: IA 113501) |
| Enumeration Date | 2022-02-02 |
| Last Update Date | 2026-07-16 |