| NPI | 1568858249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: OH OT.007370) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MI 5201007605) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2015-04-09 |