| NPI | 1114586419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MN 105938) |
| Additional Taxonomies | 225XN1300X Occupational Therapist, Neurorehabilitation (Licence: MN 105938) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2020-02-09 |