| NPI | 1447693148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MN 104422) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NV 11-0104) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2013-04-11 |