| NPI | 1972950319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: TX 115452) |
| Additional Taxonomies | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: CO OT.0004486) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2016-05-16 |