| NPI | 1528569514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MI 5201009907) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: UT 10381965-4201) |
| Enumeration Date | 2018-02-24 |
| Last Update Date | 2018-03-17 |