| NPI | 1053934281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MI 5201009678) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: VA 0119007152) |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2022-03-04 |