| NPI | 1265908057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MI 5201010212) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: MI 5201010212) |
| Enumeration Date | 2018-10-18 |
| Last Update Date | 2018-10-18 |