| NPI | 1689706525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005165) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MI 520106097) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2015-10-15 |