| NPI | 1235417908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MI 5201008002) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 114315) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2011-07-29 |