| NPI | 1124649603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: ND 1678) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MN 105840) |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2020-05-06 |