| NPI | 1386964245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: MI 5201005666) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OH OT013635) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2026-02-25 |