| NPI | 1659521409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MN 102948) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WI 4619) |
| 225X00000X Occupational Therapist (Licence: IA 001837) | |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2011-04-05 |