| NPI | 1114493434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NV OT-2130) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MI 5201010328) |
| Enumeration Date | 2018-10-15 |
| Last Update Date | 2019-03-08 |