| NPI | 1962896258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: TX 121530) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: NY 008436) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2021-02-26 |