| NPI | 1669894317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: MN 104161) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MN 104161) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2021-09-01 |