| NPI | 1053825521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MN 105537) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA 12567) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2017-11-20 |