| NPI | 1003277336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225800000X Recreation Therapist (Licence: OH 65373) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 65373) |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2020-04-02 |