| NPI | 1083116867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CA 26663) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MI 5201010064) |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2025-07-24 |