| NPI | 1316558331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: SD 1178) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: SD 0564) |
| 225X00000X Occupational Therapist (Licence: MN 106299) | |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2020-08-13 |