| NPI | 1063923050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MI 5201009797) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OH OT009746) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2017-10-17 |