| NPI | 1588806202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225800000X Recreation Therapist (Licence: MI 55624) |
| Additional Taxonomies | 225500000X Specialist/Technologist (Licence: MI 090308236) |
| Enumeration Date | 2009-03-26 |
| Last Update Date | 2009-03-26 |