| NPI | 1831676154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 120032) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MS OT3318) |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2020-06-18 |