| NPI | 1255633913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MN 103978) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: IA 001897) |
| 225X00000X Occupational Therapist (Licence: MD 243131) | |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2010-11-30 |