| NPI | 1538562848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MN 104746) |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2018-04-25 |