| NPI | 1124517677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WI 6154-26) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MN 105573) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2025-01-13 |