| NPI | 1629786686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MN 107958) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: SD 1326) |
| Enumeration Date | 2022-11-09 |
| Last Update Date | 2026-05-15 |