| NPI | 1235503301 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 225XH1200X Occupational Therapist, Hand (Licence: MI 1041100312)  | 
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MI 989940)  | 
| Enumeration Date | 2015-11-30 | 
| Last Update Date | 2015-11-30 |