| NPI | 1902204183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 117663) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MS 2917) |
| Enumeration Date | 2014-12-20 |
| Last Update Date | 2024-07-10 |