| NPI | 1578741930 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: MI CO004664) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MI 5201006044) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2008-03-18 |